A health insurance premium is the amount – typically billed monthly – that policyholders pay for health coverage. Policyholders must pay their premiums each month regardless of whether they visit a doctor or use any other healthcare service.| healthinsurance.org
Balance billing occurs when providers bill a patient for the difference between the amount they charge and the amount that the patient's insurance approves. The negotiated rate that insurers pay providers is almost always less than the provider's "retail price." Depending on the circumstances, out-of-network providers can bill the patient for the difference, or balance; this is called balance billing. Federal rules protect patients from "surprise" balance billing as of 2022.| healthinsurance.org
An out-of-pocket maximum is a predetermined, limited amount of money that an individual must pay before an insurance company or (self-insured employer) will pay 100% of an individual's covered, in-network health care expenses.| healthinsurance.org
Under the Affordable Care Act, individual and small-group health plans that are not grandfathered must cover items and services in 10 health benefit categories.| healthinsurance.org